Provider Demographics
NPI:1073806014
Name:LIANG, ZHENYU (DDS)
Entity Type:Individual
Prefix:DR
First Name:ZHENYU
Middle Name:
Last Name:LIANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 HARBOUR TOWN DR
Mailing Address - Street 2:APT #211
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-2110
Mailing Address - Country:US
Mailing Address - Phone:608-466-0608
Mailing Address - Fax:
Practice Address - Street 1:220 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:FENNIMORE
Practice Address - State:WI
Practice Address - Zip Code:53809-1036
Practice Address - Country:US
Practice Address - Phone:608-822-3770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055519-11223G0001X
WI6808-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice